Cystopexy is a surgical procedure that involves repositioning or stabilizing the urinary bladder. This is often done to correct bladder prolapse or improve urinary function, restoring the bladder to its proper location within the pelvic cavity and providing structural support.
Conditions Requiring Cystopexy
The primary condition requiring cystopexy is bladder prolapse, medically termed cystocele. This occurs when supportive muscles and tissues around the bladder and vaginal wall weaken, allowing the bladder to bulge into the vagina. Factors contributing to this weakening include vaginal childbirth, aging, chronic coughing, straining from constipation, obesity, or prior pelvic surgeries like a hysterectomy. Symptoms of a cystocele include a feeling of fullness, heaviness, or pressure in the pelvic area, a visible bulge through the vaginal opening, urinary incontinence, difficulty fully emptying the bladder, frequent urination, or recurrent urinary tract infections. In severe cases, a cystocele can prevent urination, potentially leading to infections or kidney damage.
Surgical Approaches to Cystopexy
Surgeons employ several methods for cystopexy, chosen based on the condition, patient health, and surgeon’s expertise.
Open Surgery
Traditional open surgery involves a larger abdominal incision to directly access the bladder and surrounding structures. This allows for direct visualization and tissue manipulation.
Laparoscopic Surgery
Laparoscopic surgery is a minimally invasive technique using several small incisions. A laparoscope is inserted to visualize the surgical area on a monitor. Specialized instruments perform the repair, often securing the bladder to stable pelvic structures, such as the sacrum. This method results in smaller scars and faster recovery.
Robotic-Assisted Surgery
Robotic-assisted surgery is another minimally invasive option, using a robotic system controlled by the surgeon from a console. Small incisions allow insertion of robotic arms with a 3D camera and instruments. The system provides enhanced dexterity, precision, and a magnified 3D view, aiding complex suturing and dissection. The surgeon guides the robotic arms to reposition and secure the bladder.
Post-Procedure Recovery
Following cystopexy, patients experience a hospital stay of 1 to 5 days, depending on the surgical approach and individual recovery. Immediate post-operative care includes pain management with prescribed medications and temporary use of a urinary catheter. The catheter is removed within 3 to 7 days after surgery.
Patients are encouraged to begin light activity, such as walking, soon after surgery to promote blood flow and reduce the risk of blood clots. Strenuous activities, including heavy lifting (over 10 pounds), intense exercise, and sexual activity, are restricted for 2 to 4 weeks.
Some discomfort and mild urinary symptoms like burning or frequent urination may persist for days to weeks, but these subside as healing progresses. Follow-up appointments are scheduled around 6 to 8 weeks post-surgery to monitor recovery and assess the outcome.
Potential Risks and Outcomes
Like any surgical procedure, cystopexy carries risks, though serious complications are not common. These include general surgical risks such as infection, bleeding, or adverse reactions to anesthesia. Injury to surrounding organs, such as the ureters or bowel, is also possible during the procedure.
Specific complications can include recurrent bladder prolapse or persistent urinary symptoms despite surgery. If surgical mesh is used, complications like erosion or pain may occur, though these are rare. While individual outcomes vary, cystopexy shows high success rates in improving symptoms for most patients with bladder prolapse.